Evaluation of Anoxic Brain Damage

Abstract

Patients successfully resuscitated from cardiorespiratory arrest endure anoxic and ischaemic insult of the central nervous system. The extent of brain damage determines the chances and qualitiy of survival of those patients whose hemodynamic state can be restored. Anoxic neuronal lesions occur predominantly in the cerebral and cerebellar cortex because neurons in those areas are more sensitive to anoxia. This selective vulnerability of neurons to anoxia and relative sparing of brainstem structures is probably the reason why the vegetative state more frequently follows anoxia than any other cause of nontraumatic coma [6]. The prognosis of patients in vegetative state with spontaneous eye epening, normal brainstem reflexes but without cognition is difficult to ascertain within the first days of coma [2]. Thus in contrast to brain death, a widely accepted criterion of death in medical, legal and public opinion today many medical, judicial and moral questions concerning the vegetative state remain unsolved.